I hereby give my consent for my child to participate in Salesian College Preparatory's Red & Black Girls' Basketball Skills Development Clinic ("the Clinic").
In rare instances, a medical or surgical emergency requiring treatment arises in which written consent by parents or guardians is legally required, but the proper person cannot be located. In this event, and in order to avoid delay that might jeopardize the life or health of my daughter, I hereby provide the following permission, with the understanding that reasonable effort will be made to contact me in an emergency:
I hereby grant permission to medical personnel rendering care to my daughter to accept from the staff of Salesian College Preparatory, which includes its faculty, permission and consent for emergency medical and dental evaluation and treatment, including, but not limited to diagnostic, drug, and/or alcohol testing and/or surgical procedures on my daughter. I further give Salesian College Preparatory staff permission to release pertinent health information concerning my daughter to the treating hospital and/or physician, and to give the treating hospital and/or physician permission to release copies of all medical records, laboratory, and radiology reports to Salesian College Preparatory staff.
I agree that I will be responsible for any medical/pharmaceutical costs incurred that are not covered by medical insurance. I also agree that Salesian College Preparatory, including its staff, agents, or employees, will not be liable for unknown or unforeseen conditions arising from medical/nursing treatment or medications received by my daughter. I voluntarily agree, covenant, and promise to accept and assume all responsibilities, and risk for injury, death, illness or disease or damage to myself, my daughter/son identified above, or to my property arising from my daughter/son’s participation in the Clinic, and the use of the premises, facilities, equipment, and services offered by Salesian College Preparatory in connection with the Clinic.
I, for myself and for my daughter, voluntarily release and forever discharge and covenant not to sue Salesian College Preparatory and its staff including its coaches, agents or employees, and all other persons or entities affiliated therewith, from any and all liability, claims, demands, actions or rights or action, which are related to, arise out of, or are in any way connected with my daughter’s participation in the Clinic, any and all activities related to the Clinic, and the use of the premises, facilities, equipment and services offered by Salesian College Preparatory in connection with the Clinic, including, but specifically not limited to any and all negligence or fault of Salesian College Preparatory and its staff, including its faculty.
I further agree, promise and covenant, on behalf of myself and my daughter/son specific above, to hold harmless and to indemnify Salesian College Preparatory and its staff, including its faculty, agents or employees, and all other persons or entities related to Salesian College Preparatory, from all defense costs, including attorney's fees, or from any other costs incurred in connection with claims for bodily injury, wrongful death or property damage brought by me, my daughter, or on our behalf.
I further acknowledge that I am in the best position to determine the physical ability of my daughter to participate in the Clinic, and acknowledge that my daughter is in good physical and mental health, and is not suffering from any condition, disease, or disablement that would or could potentially adversely affect participation in the Clinic.
I HAVE READ THIS FORM, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS FORM IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.